Sunday, February 19, 2012

The first was for an injury he sustain in MMA practice. He was afraid he had broken a rib. He had not.

The second was for a panic-attack-from-hell that he had as a result of consuming something (or several somethings) at a party. He thought he was dying. He had his friends call him an ambulance which took him to the ER were they gave him IV fluids and an anti-anxiety medication.

The third was 10 days after he had his tonsils removed. He hadn't bothered with the routine anti-biotics he was prescribed and he was spitting up blood. He could not wait a few more hours to go to the doctor's office. At the ER they gave him sympathy, considered giving him antibiotics, but got an afternoon appointment with the surgeon. He was prescribed antibiotics which he did not take because "the doctor didn't think it was an infection." I argued that the doctor must have thought it was an infection, because he prescribed antibiotics. Finally I just started handing them to him on schedule.

The fourth was yesterday. Friday evening he was at a bonfire with friends. He was drinking, did something foolish, and hit his head hard. At noon he felt he had to have medical attention because he had such a terrible headache. We took him to the urgent care clinic, but he reported symptoms of a concussion and they sent him to the ER. There he was given Tylenol, had a CT scan and was told he was fine.

He has this pattern with his health. He has a symptom, is afraid he is seriously ill and must see a physician. The physician sees him, prescribes some treatment, and Gary goes home, ignores the treatment and usually feels better very quickly. He seems to have a strong need to be seen by a professional. This does not translate into any desire to follow up on the treatments.

And I have noticed at every emergency room visit, at some point when we are waiting for something or other, he will say, not necessarily to me, "I just want to be taken seriously."

My usual approach won't work with this one. I cannot just let him do what he is going to do and deal with the consequences himself.

Okay, I wrote that and then thought "sure I can. I just don't want to."

I can't imagine going back to yesterday and saying, "Sweetie, you have no bruise, no bump, and your eyes look fine. You are severely hung over and you hit your head. Of course you feel miserable. Drink some water and take a pill."

I wanted to say that. I think I would have been right to say that. On the other hand, what if I had been wrong? What if he had had a concussion? I no longer trust his reports of his own health. I don't think he is lying. I think he is genuinely frightened by what he is feeling. He needs the reassurance. Maybe he needs the attention from me. Even if I am right about that, he still could be seriously hurt.

Only the thing is ... I seriously cannot afford this. Roland and I are living on a very tight budget paying off debts from last year. Two thirds of that debt is a combination of Gary-related car expenses and Gary's medical bills. Before this latest ER visit I had hoped we would pay off all the debt before my mother moved in, but thought more realistically, we might make it by the end of summer. I know that "can't afford it" is relative. I know that if he had had a concussion and needed surgery I would be resigned to paying off a higher debt load. I would be worried, but I would cope.

Right now though? Right now I am angry because even if he had been seriously injured, it still would have been the result of getting drunk. He doesn't seem to think that is a big deal. When he was in the emergency room after taking the stuff at the party he seemed quite sincere when he said that he learned never to do that again. This time he says that drinking is just what teenagers do. (Does that mean that when he turns 20 in the fall he will change? I'm not holding my breath.) He won't try to do acrobatics and land on his head though. I do not want to be responsible for this bill.

On the other hand, he really can't afford it. He has to be at least $1000 behind on his car payments. He doesn't have a job and wants to move out. I want him to move out too, and saddling him with more debt won't help.

We've pretty much decided that we are going to take responsibility for the larger portion of the bill and make him responsible for a smaller part of it. The easiest way to do that will be for us to pay the money owed to the hospital and make him responsible for the bills from the docs. (We will get one from the ER physician and from the radiologist who looked at the CT scans). That feels right to me. It means he has to deal with the real-world consequences of his actions, but we have soften the blow enough that it is not going to destroy him. It will hurt real bad though.

Roland and I are getting resentful and that is not a good thing. Gary has been talking about wanting to buy a tablet computer. In the ER he told me that he was thinking that maybe all he could afford would be a Kindle Fire. I ranting about how much money he owes and our struggles to pay off the debts, but I didn't. On the way home I did tell him that the changes that he was seeing in our lifestyle were a result of trying to get out of debt and that I did not think Roland and I were going to be willing to take responsibility for the $800 (or whatever) the ER visit was going to cost. I told him we would help, but he was going to have to be responsible for some of it.

Right now the very best thing about my mom moving in is that Gary is determined to move out first. I warned him last summer that if this happened he and Brian would have to share a room. He losing the private bedroom when my sister shows up in the middle of May. Since I started this post he has told me that he called his social worker to learn about getting assistance moving out. He just has to find a job first. (He also told me that he is feeling great and he googled his symptoms. He is sure he had a severe concussion. CT scans can't always pick those up, you know.)

I love the boy, I do, but I am past ready for him to move.

I'm angry that he agreed to do chores to pay for his rent and he has not. I'm angry that he leaves dirty dishes in the basement and I have to nag at him to get them back up. I'm angry that he doesn't understand that not doing chores and making messes is something I can tolerate in a high school student, he has passed into a different realm for me.

I'm tired of hearing about all his fantastic plans. I'm tired of feeling resentful.

In my experience an ER visit is at least $600. That's for walking in. Then you are charged for everything they do. In this case there will be a charge for the CT scan and I have no idea how much that will be. I am guessing at least $200. There is always a separate bill from the ER physician. When you have X-rays or CT scan there is also a charge from the radiologist who read it.

The answer about poorer people is complicated. If you are poor enough to qualify for Medicaid then the ER is free. Medicaid payment rules are very restrictive and many physicians resist taking Medicaid patients. So people on Medicaid will often go there to the ER for primary care. The ER we were at last night had a separate system they call "Fast Track" for people who don't really need the services of an ER. After they are checked in and triage'd they go to an office that is more like a regular physician's office. Whatever they are charged is less. I don't think that is typical.

ER's in the US are not allowed to talk to you about money until after you have been treated. That means that poorer people who are not on Medicaid and not privately insured, can go, be treated, and then have to tell the nice lady at the desk that they don't have the means to pay. A payment plan will be set up. Overwhelming medical bills are the number one reason that people go bankrupt in the US.

There are free and low cost clinics, but not every place has them. They are not open 24/7 and you can wait all day to be seen. You don't go there if you have an emergency, and you probably really don't want to go if you have a child crying with an ear infection.

Part of the problem, which we are trying to fix, is that most accessible care for the poor is the ER, and that is also the most expensive. One of the reasons my bill is so high is that the hospital has to distribute the cost of the bills that go unpaid on those of us who can pay. I think it makes infinitely more sense to do this through my taxes, but there you are.

So, the short answer. Poor people either don't go or risk going bankrupt.

thanks for the reply, yondalla. i do find it interesting -- but of course i have the luxury of finding this interesting (because i'm not subject to it).

the first thought that strikes me is how strange the incentives can be, when it comes to societal services such as healthcare; that very poor people are incentivized to go to the ER even though that is the most expensive form of treatment.

it sounds terrifying to think that if your health is very poor, that you will have to either forgo treatment, or risk going bankrupt. i wonder if adults repress the thought of this out of their minds, in order to cope.. ?

I am one of the people in the US who has "good" insurance through my employer. In my case that means it cost me $20 to go to a regular physician. I also pay between $10-$30 for any prescription.

Other things, like surgery, ER visits, non-routine tests (x-rays), are covered after the first $1000 each calendar year. In my insurance that deductible is per person, with a $1000 deductible for the family. If this ER visit bills come to at least $1000, Gary will have met his deductible for the year. After this he will pay 20% of any ER bills.

All the comments about how much it costs to go to ER sounds horrendous to me. I am in the UK. We complain all the time about our Health Service and how long we have to wait etc, but we never have to worry about how much it costs as it is free. We see Doctors whenever we want and if my kids had any knocks and tumbles I would just take them to A&E to be checked out just incase. I should imagine if I had of needed to pay I may have not been there as often! It makes me appreciate what we have here!!

There is a medical condition for what he is doing. Saying something is really wrong and needs to see a doctor, gets the docs advise, won't do what doc said, and then insists on going to the ER. It is really truly a medical condition. Look into it. Spending a little money elsewhere, might help save you money other places. As for the slobiness and stuff, welcome to the young adult age. Just got oldest daughter and boyfriend to move out on their own, by raising their rent. Her apartment is SPOTLESS! I was surprised.

About Me

Daughter, sister, wife, mother, foster-parent blog writer, philosophy professor ... I am and have been many things. These days my identities as a teacher of bioethics and the daughter of a woman with Parkinson's and dementia lead me to agree with Peter Singer, "It's different when it's your mother."